Provider Demographics
NPI:1053471375
Name:BERLY, LAUREN SUE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:SUE
Last Name:BERLY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3422
Mailing Address - Country:US
Mailing Address - Phone:617-731-8783
Mailing Address - Fax:
Practice Address - Street 1:1419 BEACON ST
Practice Address - Street 2:SUITE 31
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-731-8783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1028001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7623340OtherAETNA
MA732686OtherTUFTS HEALTH PLAN
MAPO2018OtherBLUE CROSS BLUE SHIELD MA
MAPO2018Medicare ID - Type UnspecifiedMEDICARE B